Phimosis: how to treat a tight foreskin in adults

Written by: Mr Rajesh Kavia
Published:
Edited by: Kalum Alleyne

Having a tight foreskin can be extremely uncomfortable, and in some cases leads to severe pain, irritation and infection. Expert consultant urologist Mr Rajesh Kavia describes this condition in greater detail, from causes and symptoms to complications and treatments. 

 

A man who is feeling distressed because of his tight foreskin

 

What is phimosis and what causes it?

Phimosis is a tight foreskin that cannot be retracted fully and comfortably below the glans. It can occur both in the flaccid state or be tight with erections. If the foreskin does retract and then become stuck this is called ‘paraphimosis’.

 

When does phimosis become a problem in men?

Phimosis can be a problem for men if it results in pain, discomfort, irritation or infections.

Pain may occur during intercourse when the foreskin cannot retract back, this can also lead to the skin splitting which can be a cause of irritation. If patients are unable to clean the glans infections, known as balanitis, can occur. There are other forms of inflammatory conditions which also cause balanitis. Phimosis is common in men with diabetes and is related to a condition called lichen sclerosis et atrophicus (Also known as Balanitis Xerotica Obliterans – BXO).

 

Can serious complications occur if it's left untreated?

Recurrent infections and pain are the most common complication. If the condition is due to BXO then there are risks of significant scarring and closure or stenosis of the urethral meatus (the opening at the tip of the penis), which can cause issues with the flow of urine. Very rarely tight inflamed foreskins can be related to cancers of the penis.

 

What non-surgical options are there?

If the foreskin is mildly tight daily retraction and sometimes steroid creams can be helpful. If one is treating an infection, antibiotics or antifungal creams are used.

 

What surgical options are available?

The options for surgery depend on the cause and the surgeon will be able to discuss this with you, but generally if the foreskin is healthy but tight, then a frenuloplasty or perputioplasty could be considered. Both of these procedures aim to preserve the foreskin while loosening the skin to allow retraction. These carry less risk in terms of cosmetic or sensory change.

 

The other option is a circumcision – where the whole skin is removed and then the skin edges sutured together. The risks of surgery are infection, bleeding, pain for a few days, cosmetic dissatisfaction and sensory change. The operation can be done under local or general anaesthetic depending on the patient's preferences.

 

After circumcision, is foreskin restoration possible?

This is difficult if the skin has been excised, though there are devices on sale claiming to restore the foreskin. However, the evidence of these devices actually working is limited.

 

If you’d like to discuss this or any other urological issue with an expert, you can visit Mr Kavia’s Top Doctors profile and request an appointment.

By Mr Rajesh Kavia
Urology

Mr Rajesh Kavia is a highly revered, trained, skilled and experienced leading London-based consultant urological surgeon, who specialises in areas such as urinary incontinence, urinary tract infection, prostate-related conditions, as well as general paediatric urology. He possesses a special interest in functional urology and incontinence in males and females.

The trusted Mr Kavia treats all manner of urological problems from his private clinics across London, and was the first surgeon within the M25 to perform the Urolift procedure to treat benign prostate obstruction, using minimally invasive surgical techniques. He has specialist knowledge and expertise in relation to the treatment, diagnosis and management of prostate and bladder conditions, chronic urological pain, erectile dysfunction, circumcisions, as well as endoscopic stone management

The highly qualified doctor graduated from the esteemed Imperial College London (University of London) in 1999, impressively achieving mutliple distinctions in his MBBS. He then underwent his medical training at the prestigious Charing Cross & Westminster Medical School, prior to starting out on his research journey at the National Hospital for Neurology and Neurosurgery. 

Mr Kavia has undertaken extensive research specifically focusing on a number of urological conditions, such as being the lead author on a multinational trial of cannabis for multiple sclerosis-related overactive bladder syndrome, and in painful bladder syndrome at the National Hospital for Neurology and Neurosurgery. Alongside his clinical and research work, Mr Kavia dedicates time to teaching junior doctors, and is a course director and examiner for higher surgical trainees. He has, to-date, also published a substantial amount of articles in peer-reviewed medical journals.

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